Health Disparities in the Neurosurgical Care of Patients with Trigeminal Neuralgia

Abstract

IntroductionThere has been limited investigation into how social determinants of health (SDOH) impact treatment outcomes in patients with trigeminal neuralgia (TN). We aimed to investigate how SDOH may alter the course of clinical care for patients with TN. MethodsThe electronic medical record was queried for patients with a diagnosis of TN co-managed by neurosurgeons and other facial pain specialists at our medical center. Area Deprivation Index (ADI) served as a proxy for socioeconomic status. Multivariable linear regression models were performed using RStudio to assess the impact of social determinants on the time to neurosurgical referral and surgical intervention. Results229 patients (mean age 50 years, 74% female) were included. 135 (60%) patients underwent a neurosurgical procedure after referral, the most common being microvascular decompression (n=84, 62%) (Table 1). Most of the patients were white (76.3%) and insured by Medicare (51.8%), followed by private insurance (38.6%). Age and sex were significant predictors of time to neurosurgical referral after symptom onset, as older patients (p<0.01, Figure 3) and females (p=0.02) tended to have a greater delay between symptom onset and specialist referral. Race, socioeconomic status, and insurance status were not significantly associated with time-to-referral or time-to-treatment. DiscussionThis study found that older and female patients with TN had a longer time from symptom onset to specialist referral. Based on these data, there is no association between race, socioeconomic status, and insurance status with time-to-referral or time-to-treatment in patients with TN.